Provider Demographics
NPI:1720204506
Name:JOHNSON, DAVID DEAN (LPCC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DEAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2804
Mailing Address - Country:US
Mailing Address - Phone:619-928-2267
Mailing Address - Fax:650-458-0027
Practice Address - Street 1:3 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4279
Practice Address - Country:US
Practice Address - Phone:650-275-2546
Practice Address - Fax:650-781-1801
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YA0400X
CA7541101YP2500X, 101YM0800X
CAPCCI1792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)